|
SCREW LOCKING VA 3.5MM X 40MM 02.127.140
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.22 |
| Max. Negotiated Rate |
$1,727.76 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,126.80
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 40MM 02.127.140
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.84 |
| Max. Negotiated Rate |
$7,512.00 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Aetna Managed Medicare |
$525.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.93
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,408.50
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,220.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.80
|
| Rate for Payer: The Alliance Commercial |
$7,512.00
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 42MM 02.127.142
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.84 |
| Max. Negotiated Rate |
$7,512.00 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Aetna Managed Medicare |
$525.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.93
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,408.50
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,220.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.80
|
| Rate for Payer: The Alliance Commercial |
$7,512.00
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 42MM 02.127.142
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.22 |
| Max. Negotiated Rate |
$1,727.76 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,126.80
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 44MM 02.127.144
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 44MM 02.127.144
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 46MM 02.127.146
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 46MM 02.127.146
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 50MM 02.127.150
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 50MM 02.127.150
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 54MM 02.127.154
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5106924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 54MM 02.127.154
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5106924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 56MM 02.127.156
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5456986
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 56MM 02.127.156
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5456986
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 60MM 02.127.160
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5456985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 60MM 02.127.160
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5456985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 70MM 02.127.170
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4268748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 70MM 02.127.170
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4268748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.84 |
| Max. Negotiated Rate |
$11,212.00 |
| Rate for Payer: Aetna Commercial |
$2,522.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.58
|
| Rate for Payer: Aetna Managed Medicare |
$784.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,821.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,345.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.59
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,578.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,568.56
|
| Rate for Payer: Health EOS Commercial |
$2,494.67
|
| Rate for Payer: HFN Commercial |
$2,578.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,102.25
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.47
|
| Rate for Payer: Quartz Commercial |
$1,821.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,681.80
|
| Rate for Payer: The Alliance Commercial |
$11,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,541.65
|
| Rate for Payer: WPS Commercial |
$2,076.18
|
|
|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.47 |
| Max. Negotiated Rate |
$2,578.76 |
| Rate for Payer: Aetna Commercial |
$2,522.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.59
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,578.76
|
| Rate for Payer: Health EOS Commercial |
$2,494.67
|
| Rate for Payer: HFN Commercial |
$2,578.76
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.47
|
| Rate for Payer: Quartz Commercial |
$1,681.80
|
| Rate for Payer: WEA Trust Commercial |
$1,541.65
|
| Rate for Payer: WPS Commercial |
$2,076.18
|
|
|
SCREW LOCKING VA 3.5MM X 80MM 02.127.180
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 80MM 02.127.180
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 85MM 02.127.185
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 85MM 02.127.185
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 90MM 02.127.190
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
